Combined transcervical and unilateral-thoracoscopic thymectomy for myasthenia gravis: 2 years of follow-up.
BACKGROUND
To investigate the efficacy of combined transcervical and unilateral-thoracoscopic thymectomy for myasthenia gravis.


METHODS
There were 36 patients with nonthymomatous myasthenia gravis, undergoing combined transcervical and unilateral-thoracoscopic thymectomy and who have been followed-up for more than 2 years. To achieve maximal benefit, a transverse cervical incision was performed to give access to remove fat in the neck, which may contain residual or ectopic thymus after all thymic tissue and mediastinal fat were completely removed by thoracoscopic thymectomy.


RESULTS
There were no perioperative deaths and no cases that required conversion to median sternotomy. The mean length of surgery was 162 minutes (range, 132 to 210 min). Three sustained myasthenic crisis. Seventeen patients had lymphadenitis and 4 had ectopic thymus in the neck. There were 2 cases in which the residual superior horns of thymus were found in the neck. Average specimen weights of the thymus, mediastinal fat, and cervical fat were 44.2, 32.5, and 3.6 g, respectively. The rate of complete stable remission was 16.7% at the end of the first year, and rose to 27.8% at the second year. The effective rate was 88.9% at the end of the second year.


CONCLUSIONS
Thymectomy represents a safe and valid approach for patients with myasthenia gravis. Achieving a curative thymectomy and good cosmesis in myasthenic patients is possible with the combined transcervical and unilateral-thoracoscopic thymectomy as an effective alternative to open approaches.
Yu
Lei
L
Department of Thoracic Surgery and Neurology, Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing, China. yulei1118@sohu.com
Shan
Ma
M
Jiang
Jian
J
Jing
Yun
Y
Zang
Nan
N
Wang
Tianyou
T
Gamliel
Ziv
Z
Krasna
Mark J
MJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D013934:Thymectomy / Q000379:methods*; D055815:Young Adult